“Only an evidence-based treatment concept makes sense”

Together with his team, Professor Dr. Matthias Augustin from Hamburg-Eppendorf University Hospital in Germany continuously analyzes the treatment of venous disorders – with a decisive focus on quality of life. When talking with life, he explained why it is important to strengthen this field of study, to improve primary prevention and to explore the actual burden for the patient.

life: You are the director of the Institute for Health Services Research in Dermatology and Nursing. With what kind of subject matters do you deal with?

Prof. Augustin: One of our major subjects is the outpatient and clinical treatment of venous disorders. They are often under-diagnosed and the symptoms not taken seriously. Research on the subject is therefore important because only a data-driven, evidence-based treatment concept makes sense. For this, we use various data sources, such as the German National Association of Statutory Health Insurance Providers, the Federal Statistical Office or primary studies. So we’re comparing a wide range of individual data.

What percentage of the population suffers from venous disorders that require treatment?

Prof. Augustin: Our data refers to working adults we have analyzed in nationwide studies. About 25 percent of these have a venous disorder that needs to be treated. Since pensioners are not included, the percentage will probably be a lot higher, increasing with the demographic development. Early-stage manifestations occur most often, severe stages less frequently. That’s our opportunity! A lot can be done for these patients with initial symptoms, simply by providing education and compression therapy. 

You don’t just conduct research on venous disorders, you also treat them. What is treatment currently like – have you noticed a trend?

Prof. Augustin: Inpatient treatment has become less common and is mainly provided for deep-vein thrombosis, complications, ulcers or surgical procedures. The trend is toward outpatient treatment. This, however, poses the question of follow-up care. In the early stages, patients feel healthy, even though they suffer from a chronic condition. But their condition should be constantly monitored and their compression products adapted to suit. Ideally, family physicians should check on the compression therapy. But this doesn’t always happen because only very few have had phlebological training. I also see an opportunity for telemedicine here. 

To what extent do venous disorders affect quality of life?

Prof. Augustin: It significantly decreases with the progression of the condition. But quality of life also depends on treatment, age and comorbidities. That is why we carry out very helpful structured screenings in our institute: each patient completes a questionnaire. We will address abnormalities as well as symptoms and prioritize and formulate a treatment goal. The benchmark of our therapeutic measures is our patients’ well-being and quality of life. It has been proven by the way: even in stages with pronounced symptoms, the proper treatment with stockings results in a significantly improved quality of life.

Primary prevention can avert vein problems. What should the starting point be?

Prof. Augustin: Familial risk is an important consideration. It’s crucial to find out about that because, even as a child or young adult, the foundations can be laid. Certain jobs with a lot of standing can also be harmful. It would be worth changing work station designs. But even without predispositions, the entire population needs a lifestyle change, starting as early as childhood. So, preventing obesity, eating healthily, being active, exercising. A healthy lifestyle is not only recommended for the veins, it also combats vascular disease and diabetes, even including mortality. Furthermore, we can see a social as well as educational divide when it comes to venous disorders. This is a huge challenge for society as a whole!

What is currently missing that would ensure comprehensive professional phlebological care?

Prof. Augustin: Compared with other countries, treatment in Germany is relatively effective. This is partly down to the culture of phlebological further and advanced training, pursued by dermatologists, for instance. They see a lot of patients, for example for skin cancer screening, so they are able to detect vein problems early. Yet not enough is done after primary treatment. The risk awareness is too low. Treatment could also be coordinated more efficiently, with family physicians getting specialists, i.e. phlebologists, involved early.

In Germany, the additional designation “phlebologist” was at risk for the second time this year. Your data analysis helped prevent its removal. How did this come about?

Prof. Augustin: That’s right. At the German Medical Assembly in 2017, a proposal was submitted to remove the additional designation “phlebologist”. Within one week, we created a multi-source analysis using our data from the German National Association of Statutory Health Insurance Providers, the Federal Statistical Office and primary studies. Its findings include: first of all, we need specialists, i.e. phlebologists, for a sound diagnosis; second, the complications and extreme costs that can be caused by neglecting the treatment of venous disorders; and third, the importance of qualified phlebological care. Based on this, the proposal was rejected four years ago, as also happened this year.  

What economic advantages would it have to extend treatment?

Prof. Augustin: With the progression of the venous condition, the secondary costs increase, such as for accompanying treatment, hospitalizations, reduced productivity at work caused by sick leave or decreased performance. International studies show that proper compression therapy may cost money to start with, but the return on investment is much higher and amounts to many thousands of euros because of avoidable secondary costs.

Images: Bauerfeind, Stefan Volk